Oesophageal cancer may affect all parts of the gullet and develops as a result of cell changes in the lining of the oesophagus. Overall, the outlook is very poor. The five-year survival rate for cancer of the oesophagus is around 15%.

What is cancer of the oesophagus?

Cancer of the oesophagus or gullet develops as a result of cell changes in the lining of the oesophagus.

There are two main types of cancer of the oesophagus: squamous carcinoma, which is more common in the upper third and middle of the gullet, and adenocarcinoma, which is more common at the lower end, particularly around the junction between the gullet and the stomach.

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There has been a recent increase in the proportion of tumours arising close to the junction of the stomach and gullet, but the reasons for this are not yet known.

What causes cancer of the oesophagus?

Oesphageal cancer is more common in older people, and twice as common in men as women.

The main risk factors for oesophageal cancer are smoking tobacco and drinking a lot of alcohol. Smoking increases the risk of both SCC and adenocarcinokma, and the risk increases the longer you have smoked for. Drinking alcohol increases the risk of SCC in particular. Being overweight (obesity) is also linked with oesophageal cancer.

While a diet high in fruit and vegetables may reduce the risk of oesophageal cancer, eating a lot of red or processed meat may increase the risk. A high intake of meat which is barbecued, fried or roastes at high temperatures may also be linked with oesophageal cancer.

The risk of oesophageal cancer is higher in southern and eastern Africa and eastern Asia, and this is thought to be related to Asian pickled vegetables, and the fact that some African diets may be low in fruit and vegetables, although other environmental factors may also be involved.

Other medical conditions associated with an increased risk of oesophageal cancer are achalasia, tylosis, and Plummer-Vinson syndrome. In a condition called Barrett's oesophagus, the lining of the gullet becomes more like the lining of the stomach. Patients with Barrett's oesophagus are at an increased risk of developing cancer of the oesophagus and may benefit from regular follow-up and supervision by a doctor.

What are the symptoms of cancer of the oesophagus?

The first symptom of the disease is almost always difficulty in swallowing. There is the feeling that food is getting stuck, often behind the lower end of the breastbone. At first the problem may be only with solid food but later even semi-solids and liquids can also cause problems.

Pain felt between the shoulder blades can also develop, and something this is related to eating or drinking.

Another characteristic symptom is regurgitating unaltered food a few minutes after eating. Patients may try to avoid these problems by eating less and avoiding solid food. This inevitably causes weight loss and fatigue.

Other symptoms include heartburn or reflux, vomiting, and sometimes even vomiting of blood. The early symptoms are relatively minor and tend to creep up on patients. This means it is often several months before they consult their doctors.

How is cancer of the oesophagus diagnosed?

It can be diagnosed by using X-rays using special dye. Before the X-ray picture is taken, the patient will be asked to swallow a beaker of a whitish fluid called barium. X-ray pictures are taken as the barium travels down the gullet and into the stomach.

The procedure is completely painless and provides valuable information about the size of any abnormality present. It does not provide a firm diagnosis though any irregular narrowing of the gullet may suggest that a cancer may be present.

A definitive diagnosis is usually made through direct vision using a camera attached to a flexible tube (an endoscope), which makes it possible to take a tissue sample (biopsy). The endoscopy (sometimes called a gastroscopy) is usually carried out while the patient is under sedation.

A long flexible tube, about the thickness of a fountain pen, is passed through the mouth, over the back of the tongue and down into the gullet and stomach. The tube is connected to a camera through which the doctor can inspect the lining of the gullet and assess whether or not it is normal.

A sample will usually be taken from any abnormal or suspicious areas. After processing, these samples will be examined by a pathologist who will decide whether or not there are any cancer cells present. It usually takes 7 to 10 days after the test before the pathologist's report is ready.

Some patients need to have an endoscopic ultrasound, a test that uses an endoscope and an ultrasound scanner.

A CT scan is often performed to assess whether or not the disease has spread either locally or to the liver. This is a particularly important investigation if surgery is being considered. Occasionally patients need to have a PET-CT scan which can show up areas of active disease in the body, which can be useful to determine the stage of the cancer, and can be important is surgery is planned.

Some patients also need to have a laparoscopy, which is a keyhole type of operation to look inside the abdomen to see if the cancer has spread.

How is cancer of the oesophagus treated?

Treatment may consist of surgery, radiotherapy, chemotherapy or a combination of these.

The best chance of cure is with surgery. Patients who are in good general health and who have small tumours, that can be easily removed by an operation, have more than a 25 per cent chance of cure with surgery.

In fit patients with more advanced disease, the combination of chemotherapy and radiotherapy may be used. This can produce cure rates of around 20 per cent. The combination is sometimes used to shrink tumours in order to make subsequent surgery easier and more effective.

Unfortunately the majority of patients are not fit for intensive treatment of this type. In their case treatment will be aimed simply at relieving symptoms.

This can sometimes be done most easily using a stent. A stent is simply a kind of tube that is inserted inside the gullet to help keep it open and allow the passage of fluid and food. There are various kinds available, ranging from a simple plastic tube to a device made of metal mesh that expands once it has been put in place.

Stents can be put in place as a simple procedure at the same time as an endoscopy is carried out.

Radiotherapy can also be used to try and shrink the tumour and keep the gullet open for longer.

What is the prognosis?

Overall, the outlook is very poor. The five-year survival rate for cancer of the oesophagus is around 12%. Survival rates are higher in younger patients who are fit enough for intensive treatment, with cure rates of 20 per cent or more.

There are two types of liver cancer, primary and secondary. Primary begins in the liver whereas secondary is caused by the spread of cancer...
Reviewed by
David Maxton
and Dr Jeff Butterworth, Gastroenterologist

The materials in this web site are in no way intended to replace the professional medical care, advice, diagnosis or treatment of a doctor. The web site does not have answers to all problems. Answers to specific problems may not apply to everyone. If you notice medical symptoms or feel ill, you should consult your doctor - for further information see our Terms and conditions.

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